Success is possible under PDGM. Prepare your agency with the PDGM Impact Analysis.

The data and insights provided by your custom PDGM Impact Analysis will provide clarity on how 2020’s sweeping changes will affect your agency’s payments.

Most importantly, your report will include recommendations to help your HHA successfully prepare for PDGM’s reimbursement impact.

PDGM Impact Analysis: Preparation Is Paramount

Your custom PDGM Impact Analysis evaluates:

• Overall Reimbursement Impact
• Therapy Visit Reimbursement Impact
• Full Payment & LUPA: PPS to PDGM
• Invalid Primary Diagnosis under PDGM
• Clinical Groupings & Top Ten Diagnosis Statistics
• Source of Admission & Episode Timing Statistics
• Functional Category Distribution Statistics
• Comorbidity Adjustment Distribution Statistics
• Recommended Preparations for PDGM

*The analysis also includes a comparison of agency data to the average of all agencies in the state.

Download a Sample PDGM Impact Analysis

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January 1, 2020 is coming up fast! Our team of seasoned industry professionals is ready to begin creating your custom PDGM Impact Analysis.

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PDGM and Beyond

Home Health Billing

Need specific, temporary, or longer-term billing support? Let HPS relieve your billing headaches. Our seasoned professionals offer interim billing services that make transitioning to PDGM, managing claims, or helping you take control of your billing department easy and stress-free.

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As the home health landscape continues to evolve—and regulations change—it’s important to stay informed. Leave the guesswork behind. Become a member of HPS Alliance to get continuous access to exclusive industry resources, ongoing education, and personalized service. Guarantee that you’re always up to date and that your home health agency is set up for success no matter what by becoming an HPS Alliance member today.

Looking for more PDGM tips?

Download “25 Questions to Ask Your Software Vendor before PDGM”

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7 Steps for PDGM Success

For a successful transition to PDGM, Home Health Agencies must develop a thorough understanding of how PDGM changes will affect reimbursement and clinical operations. Agencies should take the following actions to begin preparation for PDGM:

1. Ensure that whoever is finalizing your agency’s ICD-10-CM coding fully understands that the primary diagnosis needs to be specific enough to meet the code list requirements that group patients into Clinical Groupings & the significance of coding all comorbidities/secondary diagnoses that are pertinent to the patient’s care plan and will impact patient care and the Comorbidity adjustment when calculating a case-mix grouping for PDGM.

2. Evaluate your current practice of providing therapy services. Determine how to provide therapy effectively for patient care and outcomes while containing costs. Consider utilizing therapy assistants, telehealth/remote monitoring, etc.

3. Evaluate your HHA’s current revenue cycle process. This will allow you to establish whether or not the agency will need to add staff or outsource billing to manage the increased billing volume.

4. Review Calculations of the impact of the PDGM model on the agency’s reimbursement overall.

5. Review Calculations of the cash flow impact for the first months of 2020 to establish if your agency will need to consider building cash reserves prior to the implementation of PDGM.

6. Review the agency’s Clinical Operations. Establish patient care plans, determine the frequency and duration of visits, and decide how to best reinforce the expectations of continued excellent patient care and outcomes under PDGM.

7. Evaluate the current level of LUPA episodes and how that will vary under PDGM.

PDGM Insights from Our Blog


PDGM Series: Functional Impairment Scoring & OASIS-D1

By Melinda A. Gaboury, CEO / Posted on: December 9, 2019

Preparing for PDGM: Step 3 in establishing a Home Health Resource Group (HHRG) and case-mix weight is patient Functional Impairment based on OASIS-D1 responses.


PDGM Series: Understanding the First Steps in Patient Grouping—Admission Source and Timing

By Melinda A. Gaboury, CEO / Posted on: November 19, 2019

Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies that are indeed convinced that preparation should be underway. The first two pieces to the puzzle in establishing a Home Health Resource Group…


PDGM Series: Top 25 PDGM Questions to Ask Your Home Health Agency’s Software Vendor

By Melinda A. Gaboury, CEO / Posted on: October 21, 2019

As home health agencies continue to plan for the implementation of PDGM there are some very important questions that agencies should be asking of the software vendors/electronic medical records (EMR) that will be utilized for clinical documentation and billing of…

Melinda A. Gaboury

Melinda A. Gaboury


D. Mark Cannon, CPA

D. Mark Cannon, CPA


Aaron D. Carey

Aaron D. Carey